APPLICATION FOR ISSUE OF AUTHORISATION TO RUN A FAIR PRICE SHOP

ANDHRA PRADESH STATE PUBLIC DISTRIBUTION CONTROL ORDER, 2001 
APPLICATION FOR ISSUE OF AUTHORISATION TO RUN A FAIR PRICE SHOP 

FP Shop Details:

Shop District: ___________________________________ FP Shop Mandal: _________________________________________
 FP Shop Dealer ID: ______________________________ Authorization No: __________________________________________
 FP shop Address: _________________________________________________________________________________________

FP Shop Dealer Details:

 Dealer Name (In Capital Letters): ____________________________________________________________________________
Father/Mother Name: ________________________________ Age & Date of Birth: ____________________________________
Caste: _________________________________________Educational Qualification: ____________________________________

Address: Door No: _____________ Locality/Landmark: ___________________________ Village: _______________________
 Mandal: ______________________ District: __________________________ Pin code: _______________________
 Mobile Number: _______________________ E- Mail ID: ______________________________________________

Whether he is physically handicapped (YES/No) _______________________________________________________________
Whether the applicant is connected with any other business run either by himself or by any member of his family and if so give
details__________________________________________________________________________________________________
Whether any number of the applicant’s family has been issued authorization to fair price shop earlier and if so give the details
________________________________________________________________________________________________________
Whether any of his blood relations is working in revenue/CS Dept. /CS corp. and if so give details
________________________________________________________________________________________________________
Village location, Door number, when the applicant wants to run fair price shop, if he is selected
________________________________________________________________________________________________________
Whether he can raise the sufficient funds to run fair price shop with his own funds and if so give source or whether he needs
institutional finance________________________________________________________________________________________
Whether he was convinced earlier for offence under central order issued by the State/Central under E.C
Act._____________________________________________________________________________________________________
Amount, Challan number and date through which fee for issued authorization `and application renewal has been submitted
________________________________________________________________________________________________________

I have carefully read the conditions of authorization under the Andhra Pradesh State
Distribution Control Order, 2001 and I agree to abide by them.

(a) I have not previously applied for such authorization in this district.
(b) I applied such authorization in this district on and was not granted.
(c) I hereby apply for renewal of authorization ……………………………………………………………………………………………………………
………………………………………………………………….which is enclosed.
(Strike of the Clauses not applicable)

 Signature of the Applicant
Procedure (following to be enclosed):

1) Application Form* Contact Details:
2) Copy of Authorization letter* Land Line Number :
3) Latest renewed food grains and kerosene License* Mobile Number :
4) PHC Certificate (Certificate is enclosed in case he is physically handicapped). E- Mail ID :